Tag Archive for: folate

Should I Use Folate or Folic Acid?

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In the past few years, there has been a trend toward using folate, the natural form of vitamin B9, versus using folic acid, the synthetic form. Many times I’ve answered the question “Which form is better? I’ve heard…” I said on Tuesday that the study on folic acid, blood lead levels, and autism had a lesson. That lesson is this:

Folic acid from enriched foods or supplements is equivalent to folate from foods or supplements.

The body efficiently converts folic acid to folate, and from that point, there’s no difference in the benefits to the mothers or their babies. Even in women who have the MTHFR mutations, folic acid is still beneficial.

This won’t close the door on people who insist that folate is the better choice, but we know their assertions aren’t based on research. Every study on the impact of folate/folic acid on pregnant women and their offspring used folic acid. That’s the form that was put into grain-based foods beginning in 1998 with the objective of reducing birth defects; the reduction in birth defects has been estimated at 70%. Further research has demonstrated benefits to the children of mothers who supplemented with folic acid, such as reductions in allergies, asthma, and ADHD.

The Bottom Line

The results from the study on the benefits to the offspring of women who may have been unintentionally exposed to lead is that folic acid intake is directly related to prevention of harms to their babies. It also illustrated that megadosing is not required. The lesson is that folic acid, whether added to grain products or in supplements, is an effective form of B9 to accomplish that goal.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Folic Acid, Lead, and Autism

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Every once in a while, a research study provides an important lesson as well as some interesting findings. Let’s begin with the study.

During 2008 through 2011, researchers selected almost 1,900 pregnant women as subjects from 10 cities across Canada for the study. The overall goal was to identify environmental impacts on the mothers and children; this is an ongoing study. In this case, researchers looked at children who were diagnosed with autism, based on standard diagnostic criteria. Understand that autism is on a spectrum, and they used behaviors associated with autism when the children were three or four years old. They also tested maternal lead levels, folate levels, and folic acid intake in early pregnancy.

Researchers found there was an inverse relationship between blood lead levels and folic acid intake—as folic acid intake increased, the blood levels of lead decreased. The autism scores were also lower in the children of mothers who had sufficient folic acid intake, verified by their blood folate levels; 400 mcg intake was sufficient, and taking more folic acid didn’t provide additional benefit.

What does it mean? No one has to megadose folic acid to benefit their unborn children in response to environmental toxins. And even if pregnancy isn’t part of your future, the folic acid had a protective effect; if you suspect you have lead pipes, additional folic acid is a good idea.

What was the lesson? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

The Bottom Line on Folic Acid

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Based on the studies covered in the Tuesday and Thursday posts, you may be confused about what you should do when it comes to folic acid, especially if you’re pregnant or thinking about getting pregnant. I read a lot of research to come up with this analysis and here’s what I found.

There are three areas of concern:

  • Too much folic acid could mask a B12 deficiency during pregnancy; there’s no research to support that. It can happen in the elderly who have problems absorbing B12, but doesn’t seem to happen in women of child-bearing age.
  • Excess blood folic acid may be related to tumor acceleration; there’s some rodent research to suggest some relationship but nothing in humans. They have also cited research on folic acid supplementation and prostate cancer. I examined numerous studies and there’s no clear relationship; some show some type of relationship, others show a reduction in risk.
  • There may be some effect on the children of mothers who get too much folic acid; there’s one study that suggest an increase in asthma in offspring but most studies seem to demonstrate a protective effect.

Where does that leave us? Most of the studies are not done very well when it comes to folate and folic acid intake. The folic acid intake is dependent on Food Frequency Questionnaires, which have severe limitations. The methodology for determining blood folic acid levels vary from study to study. The associations between intake and problems are weak at best.

But when it comes to pregnancy, there may be a solution. In a recent study, researchers examined the relationship between neural tube defects and the red blood cell folate level. As the estimated levels increased, the risk of neural tube defects decreased. The level which seemed to provide the lowest risk of neural tube defects was greater than 1,000 nmol/L. This was a single study and used interesting statistical techniques, but it seemed to provide for more precise folic acid supplementation.

 

The Bottom Line

The benefits of folic acid on neural tube defects have been impressive, and the concern over excess supplementation may be legitimate or not. It could be that women process folic acid too well or not well enough and that could impact dietary and supplementation intake. Research on the MTHFR polymorphisms continue with no recommendation for its diagnostic use at this time.

If you’re concerned, talk with your physician about getting a blood folate test. Levels of RBC folate levels can be estimated from that result. One key point: the test would be most beneficial before conception because neural tube defects happen in the first month of pregnancy. Still it’s one way to be more cautious in spite of the limited risk.

Let me close by saying that in all the research I did, what I could not find is any association between reasonable folic acid intake and miscarriages or other issues during pregnancy. Folic acid appears to be safe and protective and should be a part of prenatal nutrition.

If you want to know more about having the healthiest baby you can, check out Healthy Babies: From Conception to Breastfeeding. It’s available as a CD or MP3 download.

What are you prepared to do today?

Dr. Chet

 

Reference: BMJ 2014;349:g4554 doi: 10.1136/bmj.g4554